The World Health Organization (WHO) gave the new coronavirus the name “COVID-19” on February 11, 2020, and declared it a pandemic on March 10, 2020.  A review of 22 studies on similar human coronaviruses such as SARS (Severe Acute Respiratory Syndrome coronavirus), MERS (Middle East Respiratory Syndrome coronavirus) and HCoV (endemic human coronaviruses) finds that COVID-19 is not more severe than many flu viruses (J of Hosp Infect, Feb 6, 2020). However, it is incredibly contagious because no human has yet been shown to have been infected with this virus previously, so nobody is immune to it. It probably started in some animal, was transmitted to humans and was first identified in Wuhan, China. It is now being transmitted from person to person in countries all over the world. There is no scientific evidence whatever that this virus came from a bio-warfare program or any other type of conspiracy.

• COVID-19 can infect anyone, but many people do not have any symptoms or have only mild symptoms. People over 65 and those with other diseases or a weakened immune system are more likely to have serious symptoms, severe disease and even death.  Older people are at higher risk for complications because aging normally decreases a person’s ability to fight off invading germs.  Among the people in the U.S. who have died from COVID-19, a large number have been in their 60s, 70s, 80s or 90s.

• It is spread by contagious respiratory droplets, primarily from person-to-person.  After a sneeze or cough, the virus can float in the air for up to three hours and can spread droplets up to six feet.  Less commonly, it can be acquired from surfaces such as door handles, furniture, clothes or any other object that you may touch.

• COVID-19 has an incubation period of about 2-10 days after exposure to an infected person or surface.

• The virus lives in the nose and throat and then goes down into the lungs. Early symptoms include fever, cough, and shortness of breath. Intestinal symptoms and culture of the virus in stool have been reported.

• Infected people keep the live virus for an average 20 days and can continue to be contagious up to 37 days, even if they have no symptoms (The Lancet, March 11, 2020).

• There is no known effective treatment, but people with normal immune systems are likely to get rid of the virus and feel better within a few days. We do not know if the drugs currently used to treat flu will help to treat more severe symptoms of COVID-19.  Drugs used to treat malaria are also being investigated.  See my report on The Search for Drugs to Treat COVID-19

• You are at increased risk for complications if you have any defect in your immune system: a history of heart attacks, cancers, diabetes, lung disease, auto-immune disease, kidney disease, a chronic infection or any other serious illness. So far, of the most seriously ill COVID-19 patients, 30 percent had high blood pressure, 19 percent had diabetes, and 8 percent had serious heart disease.  People with an existing lung disease (asthma, bronchitis, emphysema, and so forth) are at high risk for complications.

• Deaths from COVID-19 usually occur when it progresses to the lungs, which can then fill with fluid and smother the person to death.  It can also cause your immunity to become so active that the same cells and chemicals that attack germs can attack you (called “cytokine storm”).

• You can reduce your likelihood of being infected by washing your hands very frequently or using alcohol-based sanitizing products on your hands and on any surfaces that may have been exposed to respiratory droplets from infected people. Do not use very hot water or plain alcohol to clean your hands as they can damage your skin and offer no advantage over just soap and water.

• Hard surfaces such as metal, glass or plastic can remain contagious for about 10 days at normal room temperatures, and at near-freezing temperatures they can remain contagious for about 18 days. If a suspect package is shipped to you, you may want to wait for several days before opening it.  One study showed that the virus lives on most metal about 3 hours, copper 4 hours, cardboard 24 hours, stainless steel 13 hours, and plastic 16 hours (NEJM, Mar 17,2020).However, most virus particles break down in minutes or hours outside a living host, and you are far more likely to acquire the virus directly from another person.

• Ordinary face masks are almost useless for preventing infection, but if you are infected, a mask may decrease spread of the virus to others. A mask may also discourage you from putting your fingers on your face and mouth to bring the infection to you.  They can also help to keep you from infecting other people, since they will block your coughs or sneezes from becoming airbourne. Medical-quality masks are in short supply and should be reserved for health care workers, so ordinary citizens are now being encouraged to make their own cloth masks, which can be washed in soap and water after each use. A variety of designs and instructions for making masks are available on YouTube, and even a bandana is more effective than nothing. The CDC may soon issue new guidelines for wearing homemade masks whenever a person is out in public.

• Where possible, people with weak immune systems should avoid crowds, hospitals, and any unnecessary exposure to potentially sick people.

• Federal, state and local governments, health departments, schools and businesses are issuing orders and recommendations for cancellations, closures, social distancing, stay-at-home orders, travel restrictions and other measures to help stop the spread of COVID-19.  If you are at high risk for complications of COVID-19, you may want to follow even stricter avoidance or self-isolation measures to reduce your chances of exposure.

• The U.S. Centers for Disease Control and Prevention (CDC) website is updated regularly and is an excellent source of current information.

Good News: Researchers tested the immune response to COVID-19 in an otherwise healthy woman in her 40s, who required hospital admission (Nature Medicine, March 16, 2020). Three days after the patient was admitted, her immune system had produced huge amounts of several immune cells that are used to show that a person has recovered from a seasonal influenza infection. This test indicated that she had recovered in three days. Even though COVID-19 is caused by a brand-new virus never seen before, an otherwise healthy person was able to develop a healthy and normal immune response that signifies recovery. This helps to explain why more than 80 percent of COVID-19 cases are mild-to-moderate. However, other studies show that people can continue to shed the virus for 10-37 days (The Lancet, March 11, 2020), so they may still be contagious, even though they have “recovered.”

Intravenous hyperimmune globulin injections and monoclonal antibodies from the blood of recovered persons look like they will be very effective and will be available very soon (JAMA, published online March 27, 2020). Blood from patients who have recovered from COVID-19 contains IGG and IGM antibodies that can kill the virus (JAMA editorial, March 27, 2020) Blood tests will soon be approved to see if a person has been infected with COVID-19 and is therefore now immune. These people may then be able to treat people who are currently infected, and to donate blood with the antibodies that could be helpful in treating COVID-19 patients.

Trials for a vaccine for COVID-19 will start in May 2020 (NIH News, March 16, 2020), and we should have a vaccine to prevent infections in 12 to 18 months.

My Recommendations
• Try to avoid contact with sick people, but if you are exposed to someone with fever or respiratory symptoms, wash your hands and face with soap and water for at least 20 seconds, or use an alcohol-based hand sanitizer.  Wear a home-made cloth mask when you are out in public.
• Avoid touching your eyes, nose, or mouth with unwashed hands. Infected hands will bring the virus up to your face where it can enter your nose, mouth or eyes.
• If you develop symptoms that may be COVID-19, check with your doctor or health care provider.  Sick people should stay at home (e.g., from work, school or social activities).
• Coughs and sneezes should be covered with a tissue, followed by disposal of the tissue.
• Frequently touched objects and surfaces should be cleaned regularly with an alcohol-based disinfectant.

There is a tremendous amount of misinformation on the internet and in social media. If someone offers you a product or advice for treatment or prevention of COVID-19, be skeptical and check to see what the reliable sources such as WHO and CDC recommend.  For example,
• There is no evidence that vitamin C will help to protect you from any infection unless you have a deficiency, and you can easily meet your requirements for vitamin C with ordinary foods such as oranges.
• As of today, there is no evidence that higher air temperatures will kill the coronavirus. Influenza and colds tend to be seasonal, but we do not yet know if COVID-19 will diminish with warm weather.
• Drinking water frequently or gargling will not reduce your chances for infection.
• So far, there are no home test kits for COVID-19 that have been approved by the FDA. They should be coming soon.

Updated 3/30/20